In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of paediatric hospital admission, yet the evidence to support current treatment recommendations is limited. The TRansfusion and TReatment of severe Anaemia in African Children: (TRACT ISRCTN84086586) is a 3x2x2 factorial controlled trial involving 3954 children (aged 2m to 12y) with severe anaemia (haemoglobin <6g/dl). The trial has been designed to address the poor outcomes following SA in children in sub-Saharan Africa, which is associated with high rates of in-hospital mortality (9-10%), 6-month case fatality (12%) and relapse or re-hospitalisation (6%) indicating that the current recommendations and/or management strategies are not working in practice. Hospitalised children will be enrolled at 4 centres in 2 countries (Malawi, Uganda) and followed for 6 months. TRACT trial is designed to answer 4 simple questions. Q1 and 2: which children should receive a transfusion (since current guidelines recommend transfusions only in children with a Hb <4g/dl (or <6g/dl if accompanied by complications)); and how volume to transfuse in each transfusion event?. Q3 and 4: Since the major factors related to poor longer term outcome are micronutrient deficiencies and sepsis would post-discharge multi-vitamin multi-mineral supplementation versus routine care (folate and iron) for 3 months and/or cotrimoxazole prophylaxis for 3 months versus no prophylaxis improve outcome and prevent relapse. Primary outcome is cumulative mortality to 4 weeks for the transfusion strategy comparisons, and to 6 months for the nutritional support/antibiotic prophylaxis comparisons. If confirmed by the trial, a cheap and widely available ‘bundle’ of effective interventions could lead to, if widely implemented, substantial reductions in mortality in African children hospitalised with severe anaemia every year. The trial started in Sept 2014 and currently 2700 children have been enrolled. We expect the trial results to be available in 2017.
Should we Transfuse the Sick Child in Africa?
-
The challenges in the prehospital management of sick kids
Phoebe Adams, , 2016, The Talks smaccDUB 2016, Uncategorized, paediatics, prehospital, SMACCDub, Trauma, 0
Fight, Flight and (more commonly) Freeze are common reactions when faced with the critically ill child. In this talk...
-
The magic of remote ischaemic preconditioning
Ka, , 2016, The Talks smaccDUB 2016, acute myocardial infarction, Cardiac Surgery, ischaemic preconditioning, ischemic preconditioning, X remote ischemic preconditioning, 0
All you need to know about the promise and current reality of remote ischaemic preconditioning for clinical practice.
-
Assault on the RV – Pulmonary Hypertension and Heart-Lung Interactions
Ka, , 2016, The Talks smaccDUB 2016, Pulmonary hypertension, Resuscitation, right ventricular failure, 0
Pulmonary hypertension is commonly seen with critical illness, and the resuscitationist must be prepared to tackle this complex problem.
-
The ABC of ICU – The A is for antibiotics
Ka, , 2016, The Talks smaccDUB 2016, antibiotics, Resuscitation, Sepsis, 0
We debate perpetually how best to resuscitate patients - ABC! For the critically ill, septic patient the only therapy...
-
When PHARM meets the Farm: Rescue, Resuscitation & Retrieval in the Agrarian Environment
Ka, , 2016, The Talks smaccDUB 2016, agriculture, death, ems, entanglement, injury, tractor, Trauma, 0
Farmers work long hours, in isolated areas using older machinery. When EMS is called to the scene of an...
-
Fiji Critical Care Jenga
Ka, , 2016, The Talks smaccDUB 2016, critical care, developing, Fiji, Jenga, 0
Providing critical care in a developing system is extremely challenging and can be likened to "Critical Care Jenga."
-
What I learned from Dr John Hinds
Ka, , 2016, The Talks smaccDUB 2016, clinical trial, data safety and monitoring board, DSMB, 0
The evolution of medical evidence from what we think to what we know will be reviewed in an historical...
-
How to do Prehospital Research
Ka, , 2016, The Talks smaccDUB 2016, Audit, Epidemiology, Evidence, HEMS, prehospital, Quality Improvement, Research, Resource-Effective, 0
How can you build evidence by combining academic activity with pre-hospital critical care practice.